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目的评价64层螺旋 CT(64-MSCT)诊断冠状动脉粥样硬化狭窄的准确性。方法61例疑似冠心病患者在5～20 d 内行64层 MSCT 冠状动脉成像(CTA)和血管造影(CAG)检查,其中男52例、女9例,平均年龄58岁±11岁。冠状动脉成像质量按照4分标准对右冠状动脉、左主干、左前降支和左回旋支4支血管分别进行评价。CTA 与 CAG 冠状动脉病变狭窄程度以50%为界,对以上4支血管进行评价。对比分析 MSCT 诊断冠状动脉狭窄程度≥50%和<50%的敏感性、特异性、假阳性、假阴性等指标。根据斑块的成分将其分为钙化和非钙化斑块两组,对二者所导致的管腔狭窄分别进行分析比较。结果所有61例患者均获得优良的冠状动脉影像,冠状动脉成像质量评分为(3.57±0.18)分。CTA 与 CAG 对比,诊断冠状动脉狭窄程度灵敏度为95.45%、特异度为96.15%、假阳性率为3.85%、假阴性率4.55%、阳性预测值为93.33%、阴性预测值为97.40%。对于非钙化斑块所致的管腔显著性狭窄的诊断敏感度和特异度均为85.71%;对于钙化斑块所致的显著性狭窄的诊断敏感度和特异度分别为83.33%和31.57%。结论64-MSCT 可准确显示冠状动脉硬化所致狭窄性病变,可用于冠心病的无创性检查,对于钙化斑块所导致的管腔狭窄的判断特异度低。
Objective To evaluate the accuracy of 64-slice spiral CT (64-MSCT) in the diagnosis of coronary atherosclerosis. Methods Sixty-one patients with suspected coronary heart disease were examined by 64-slice MSCT coronary angiography (CTA) and angiography (CAG) within 5-20 days. There were 52 males and 9 females, with a mean age of 58 years and 11 years. Coronary Artery Imaging The right coronary artery, left main trunk, left anterior descending branch and left circumflex branch were evaluated according to the 4-point criteria. CTA and CAG coronary artery stenosis degree of 50% as the boundary, the above four vessels were evaluated. The sensitivity, specificity, false positive, false negative and other indexes of MSCT in the diagnosis of coronary stenosis≥50% and <50% were compared and analyzed. According to the plaque composition divided into calcification and non-calcified plaque in two groups, the two caused by the stenosis were analyzed and compared. Results All 61 patients received excellent images of coronary arteries and the quality of coronary artery imaging was (3.57 ± 0.18) points. The sensitivity and specificity of CTA and CAG in diagnosing coronary artery stenosis were 95.45% and 96.15% respectively. The false positive rate was 3.85%, the false negative rate was 4.55%, the positive predictive value was 93.33% and the negative predictive value was 97.40%. The diagnostic sensitivity and specificity for non-calcified plaque-induced luminal stenosis were 85.71%, and the diagnostic sensitivity and specificity for calcified plaque-induced stenosis were 83.33% and 31.57%, respectively. Conclusion 64-MSCT can accurately show the coronary artery stenosis caused by stenosis, coronary heart disease can be used for non-invasive examination, calcification plaque for the diagnosis of stenosis is low specificity.